Since 1994, this research team has studied substance use disorder (SUD) treatment in a nationally representative sample of organizations as part of the National Treatment Center Study (NTCS). The first aim of the competing continuation proposal is to continue and expand longitudinal analysis of quality improvement in service delivery in privately funded programs for the treatment of SUDs (N=350). Using an onsite data collection methodology, self-administered questionnaires, and telephone follow-ups, the analyses will look in- depth at implementation, organizational adaptation to fit local circumstances, sustainability, and discontinuation of evidence-based treatment practices (EBPs) and HIV/AIDS-related services (e.g., rapid testing, prevention). The study will also investigate in-depth, the sources of dissemination that most influence organizational decision-making. We will continue measuring the managerial innovations of continuous quality improvement (CQI) and its variants, process improvement strategies and testing and intervention for HIV/AIDS, as well as updating our collection of data on organizational structure and culture, and inter-organizational relationships. The second aim is to continue and expand collection and analysis of workforce data from counselors (N=1430) and administrators (N=280). We will continue to identify and measure sources of influence on counselor and administrator attitudes toward EBPs and practices affecting implementation and adaptation of EBPs, and continue to monitor changes in demographic and professional characteristics of counselors and administrators, focusing intensely on administrators' leadership styles. An added innovation in our research design is to follow defined cohorts of counselors and administrators across the 5-year funding period to ascertain the entire range of mobility within, between, and outside SUD treatment organizations. For both groups, we will measure influence of burnout, pay and benefits, organizational culture, and opportunity on their choices to move. For administrators, we will examine the relationship between mobility and leadership style. The third Aim is to analyze the impact of two new Federal policies and other environmental changes on the organization and delivery of treatment services in privately funded SUD treatment programs. The federal parity law and forthcoming health care reform are likely to dramatically affect demand for SUDs treatment in two ways: more persons will be covered by insurance, and there will be more extensive coverage for those insured. The legislation should thus increase treatment accessibility and availability, stimulate opportunities for integration of SUD treatment into general medical practice and increase inter-organizational competition. Combinations of competition and enhanced resources may drive continuing quality improvement and EBP adoption. Depending upon the external management of these new resources, new stakeholders may emerge and alter the inter-organizational relationships required of providers of SUD treatment services. Eventually these forces should advance organizational reconfigurations through partnering, acquisitions, and mergers. PUBLIC HEALTH RELEVANCE: Through understanding the processes by which programs adopt, implement, sustain, and discontinue use of innovative treatment approaches this project will set the stage for the design of tools to increase such adoption and implementation behavior by other public health specialists. By analyzing the dynamics of counselor and administrator turnover as well as occupational and organizational mobility, the project will provide vital information about training and management strategies that retain the workforce. Such information can inform the efforts of the federally-supported Addiction Technology Transfer Centers, which has identified workforce retention as a critical need for the field of substance abuse treatment. Generating evidence on the impact of health care reform and parity legislation on the organization and delivery of substance abuse treatment will provide public health policymakers with crucial data about trends in changes in the anticipated size, structure, and organizational patterns of treatment delivery and may demonstrate areas of anticipated service need and disparity for public health policy makers.